RPL (0009-202)54200 Avenida Madero
0009-202
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Prcaessionals Code, -and my License is in full force and effect.
License # Lic. Class Exp. Date
4310:5 C53 C`118 /.31/2(
Date 1G- - v' Signature of Contractor Zf
J OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). '
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
irlhave and will maintain workers' compensation insurance, as required by
,Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy;;no. are:,
Carrier FREMONT COMPENS' Policy No. 99-SM2-01
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner-so-as„to become subject to the
workers' compensation laws of California, an j agree iRv i I should become
subject to the workers' compensation prows) fis of Sectio 370 .of the Labor
Code, I shall forthwith comply with those p is'on'4. 'f
Date: Applicant—
Warning:
licant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all.C.ity, and State laws relating to the building
construction, and hereby authod e representative's of this City to enter upon
the above-mentioned property dr i6sp'ectio rposes.
CKJ
Signature (Owner/Ag t.) / Datej.
BUILDING PERMIT PERMIT#
JJ// ''
DATEr f (VALUATION LOT TRACT
rr// tttt Jf SIC==
JOB SITEt, S ,
APN
ADDRESS 54-M) AVEMl AMMO
I
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MfM C(Ykr t1✓RAS
RECHPAMiNSkY'POOLS COXISTbZ.D'C'i1014
54-200 AMMAMA)MRO
570 0Ll"sAld.91M RJ)
LAQUJNTA CA 92253
PALM SPRMS CA 92263
s §, .
(760)334.5527 Mffl r I '
USE OF PERMIT
?BOOL AMYOR SPA
POOL cit SPA ONLY -Al. ARIVIMAMERS SHALL HE IN PLACE, AT PRE
PL+'i.S! RR INESPECTION. POOL EQUIPMENT ENC %OSUR& N N01' !NCLUD&D
IN THIS PEP -MIT
POOL ANIS/Oki SPA 1b,0U0.Ot1 I's
n
F.33'1WAT19D COFf OF' CCiNk/" lMU t'TIO.I<i
16, 000.00
PEIZA9T VFY SITUhURY
PLAN C'HACK FEE 101--000-439-318 5111.15
CONSTRUCTION PEE 101-000-418-000 $171.00
MYC1.1ANICAL P79 -- POOL 101.004.421.000 $24,00
ZLECTRICAL FEE — POOL 101-000-420-000 $45.00
P1,tIMBrNo ME -- POOL 101-000.419.000 S".00
f
r
SUB -TOTAL C'ON`krr.RZTC13ON'Ak'TU PLAN CHECK
$378.15
IHSS PK&PAD- F.S
$0.00
T4"1AL r • [UVHT MES DIA 14OW
&1318.15
RECEIPT
DATE
BY
ed
DATE f LE
INSPECTOR
a
4
VX
t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
U
Set Backs
Electric Bond
_5
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: